MEXICO, Mo. — In 2018, Brendan and Justin Webber decided to carry on a family legacy of local pharmacy more than 40 years in the making.
The duo decided to buy out their father, Larry Webber, to control the business behind their local prescription counter.
Less than a decade later, they face large losses every day just for writing their daily prescriptions.
"At least once a day I see something that we're losing $100, $200 on," Justin Webber said.
"You want to take care of people, but then you're like, you're looking at a person as the dollars and saying, well, we we just can't do it," Brendan Webber added.
They're not alone.
High drug prices and low drug reimbursements have made it increasingly difficult to keep a pharmacy running — much less profitable. This has put immense pressure on independent pharmacies. Nationwide, more than 23,000 pharmacies have closed since 2014. In mid-Missouri, Jefferson City lost three independent pharmacies in 2023 alone.
"Margins 15 to 20 years ago were light-years different. Now, independent pharmacies 20 years ago make money," Justin Webber said. "As everybody knows, it's a struggle. It's a struggle."
Pharmacist organizations across the country, including the Missouri Pharmacy Association, place a majority of the blame on pharmacy benefit managers.
"That's what we're charging you, and that's what you pay," Missouri Pharmacy Association CEO Ron Fitzwater said. "I've lost a lot of good members in that time frame that just can't can't operate in the community anymore."
Pharmacy benefit managers
PBMs began as an integral communicators between pharmacists and manufacturers, controlling the data of drug prices and patients.
Now, Fitzwater argues the position is far too powerful, with PBMs being able to both set prices for manufactured drugs and decide what the rebate to the pharmacy will look like.
"There's been study after study after study that the PBMs, the pharmacy benefit managers, are keeping that rebate, billing the plans for the full costs of the drug and then making the differential," Fitzwater said.
Further, Fitzwater argues the pharmacists the association represents are locked in unfair contracts with no room for negotiation.
"Right now, pharmacists, when the information comes up on the screen and they show that they're going to lose money on a script — they're still required to sell it," Fitzwater said. "They'll say we'll do a better job of contracting. And he'll ask, 'well, do you like your electric rates?' I said, 'No. What I get from my electric company, that's what I have to pay.'
"If you want to be on that health plan, this is what we're reimbursing you. If you don't like it, someone else will," Fitzwater said.
The result is that pharmacy owners, such as the Webbers, know they are losing money when they write prescriptions. But they don't have the ability to pass the cost to the consumer or deny the prescription.
"PBMs came in. They kind of tried to reduce prices on medications. And at the beginning the beginning, they had the right idea, I think," Justin Webber said. "They found these loopholes and ways that they can make a bajillion dollars doing very little."
"The only people it's good for is them, to be honest with you," Justin Webber said.
Though independent pharmacies lack a corporate backing, the problem can affect larger chains as well.
Pharmacies lose out
The Webbers are feeling this pressure. On high-demand drugs, like weight loss injection — GLP-1s — or generic ADHD medicine, the duo sees the highest losses.
"They're the ones that insurance companies don't want to cover. Right. I mean, they will, reluctantly, but they don't want to pay," Brenden Webber said. "Especially the GLP-1s"
"There's a lot of stuff that we're underpaid on all day long," Justin Webber added.
Name-brand drugs, like Ozempic for GLP-1s, have been hit the hardest by PBM price increases. This has forced pharmacies to lean heavily into generic-brand drugs, still losing on many prescriptions, but at smaller margins.
"We're probably 95% generic," Justin Webber said. "Lot of the brand name we don't keep on the shelf because it's expensive."
The solution, according to Fitzwater and the Webbers, are bills currently making their way through the legislature.
Legislative action
"What we're asking at the Capitol is to bring some reasonableness to the practice," Fitzwater said. "We don't have the dollars to be able to compete on the legislative front with the big companies, the insurance companies, pharmacy benefit managers and the people that are in opposition to our bill. So ours has to be a collective."
"There are PBM reform bills in the General Assembly as we speak winding their way through. And the biggest thing is just getting those passed," Brendan Webber said. "The House needs to pass. The Senate needs to pass. And the Governor needs to sign it."
While the legislature works, all they can do is wait.
"I don't know what the exact tipping point is. I think we're getting close," Brendan said.
"It might have already been there," Justin said.
